椎间孔镜治疗退变性腰椎管狭窄症随访研究

Follow-up study of intervertebral foraminal endoscopy in the treatment of degenerative lumbar spinal stenosis

目的观察椎间孔镜270°减压治疗退变性腰椎管狭窄症的方法及远期临床效果。方法回顾性分析2014年3月—2016年10月天津市第三中心医院因腰椎管狭窄症接受椎间孔镜270°减压治疗并获得随访的47例患者临床资料。采用视觉模拟评分法(VAS)评价腰痛、下肢痛情况,Oswestry功能障碍指数(ODI)评价腰椎功能障碍情况,改良MacNab评分评价手术疗效。结果所有患者均顺利完成手术,3例患者术中出现类脊髓高压综合征,4例术后发现脑脊液漏,3例术后出现L4神经根支配区痛觉过敏。3例患者在随访期间因疗效不佳或症状复发再次手术。44例患者完成最终随访,随访时间60~88个月,平均(72.66±8.31)个月。腰痛、腿痛VAS评分及ODI评分在术后较术前均明显降低,差异有统计学意义(P<0.01),而术后各时间点之间比较差异无统计学意义(P>0.05)。改良MacNab评分优良率在术后3个月、1年、3年及末次随访分别为95.45%、93.18%、90.91%及90.91%,差异无统计学意义(P>0.05)。结论椎间孔镜270°减压治疗退变性腰椎管狭窄症能够获得满意的近期及远期疗效,值得进一步深入研究。

Objective To observe the method and long-term clinical effect of percutaneous endoscopic transforaminal 270° decompression for degenenative lumbar spinal stenosis. Methods The clinical data of 47 patients who underwent percutaneous endoscopic transforaminal 270° decompression for lumbar spinal stenosis in Tianjin Third Central Hospital from March 2014 to October 2016 were retrospectively analysed.The visual analogue scale(VAS)score was used to evaluate the low back pain and lower limb pain,the Oswestry disability index(ODI)was used to evaluate the lumbar dysfunction,and the modified MacNab score was used to evaluate the surgical effect. Results All patients successfully completed the operation,3 patients had myeloid hypertension during operation,4 patients were found cerebrospinal fluid leakage after operation,and 3 patients had hyperalgesia in L;nerve root innervation area after operation. Three patients underwent reoperation due to poor curative effect or recurrence of symptoms during follow-up. A total of 44 patients completed the final follow-up. The follow-up time was 60-88 months,with an average of (72.66±8.31)months. VAS scores of low back pain and leg pain and ODI scores after operation were significantly lower than those before operation,and the differences were statistically significant(P<0.01),but there were no significant differences at each follow-up time points after operation(P >0.05). The excellent rates modified MacNab scores at 3 month,1 year,3 years after operation and the last follow-up were 95.45%,93.18%,90.91% and 90.91%,respectively,and the differences were not statistically significant(P>0.05).Conclusion Percutaneous endoscopic transforaminal 270° decompression could obtain satisfactory shortterm and long-term results in the treatment of degenenative lumbar spinal stenosis,which was worthy of further study.